Interesting NeuroImaging Case

33 y.o. female

Clinical History• A 33 y.o. female with a PMH of asthma,

gallstones, diabetes with no documented history of diabetic retinopathy.

• She presents to an OSH with a several month history of “blurred vision” and headache. Also complains of seeing “blue lines and purple.”

• Physical examination reveals a left optic neuropathy (3/200 OS) and a right homonymous hemianopsia

Heterogeneous,partially calcifiedsellar/suprasellarmass

Pneumocephalus

Extendingmass

Mass effecton third andlateral ventricles

Differential Diagnosis of Sellar/ Parasellar Masses

SATCHMO• Suprasellar germinoma

• Adenoma (pituitary)

• Tuberculosis (granulomatous disease)

• Craniopharyngioma

• Hypothalamic glioma

• Meningioma

• Oddball causes (e.g., epidermoid cyst, Rathke pouch cyst)

Diagnosis

Craniopharyngioma• Derived from Rathke’s pouch• Often large, cystic, locally invasive• Characteristic calcified appearance on skull x-ray

and CT images• Patients often young (50% < 20 y.o.) usually

showing visual defects and signs of increased ICP• Treatment: surgical resection +/- post-op radiation

ReferencesAdams, Victor, and Ropper. Principles of

Neurology. 6th ed. McGraw-Hill, 1997, pp.672-73.

Kasper et al. Harrison’s Principles of Internal Medicine. 16th ed. McGraw-Hill, 2005, p.2081.

Gay and Woodcock. Radiology Recall. Lippincott Williams and Wilkins, Baltimore, 2000.